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Methylergonovine
Pronunciation
U.S. Brand Names
Generic Available
Synonyms
Pharmacological Index
Use
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Overdosage/Toxicology
Drug Interactions
Stability
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Mental Health: Effects on Mental Status
Mental Health: Effects on Psychiatric Treatment
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(meth il er goe NOE veen)

U.S. Brand Names
Methergine®

Generic Available

No


Synonyms
Methylergometrine Maleate; Methylergonovine Maleate

Pharmacological Index

Ergot Derivative


Use

Prevention and treatment of postpartum and postabortion hemorrhage caused by uterine atony or subinvolution


Pregnancy Risk Factor

C


Contraindications

Induction of labor, threatened spontaneous abortion, hypertension, toxemia, hypersensitivity to methylergonovine or any component, pregnancy


Warnings/Precautions

Use caution in patients with sepsis, obliterative vascular disease, hepatic, or renal involvement, hypertension; administer with extreme caution if using I.V.


Adverse Reactions

>10%: Cardiovascular: Hypertension

1% to 10%: Gastrointestinal: Nausea, vomiting

<1%: Temporary chest pain, palpitations, hallucinations, dizziness, seizures, headache, water intoxication, diarrhea, thrombophlebitis, leg cramps, tinnitus, hematuria, dyspnea, nasal congestion, diaphoresis, foul taste


Overdosage/Toxicology

Symptoms include vasospastic effects, nausea, vomiting, lassitude, impaired mental function, hypotension, hypertension, unconsciousness, seizures, shock, and death

Treatment includes general supportive therapy, gastric lavage, or induction of emesis, activated charcoal, saline cathartic; keep extremities warm. Activated charcoal is effective at binding certain chemicals, and this is especially true for ergot alkaloids; treatment is symptomatic with heparin, vasodilators (nitroprusside); vasodilators should be used with caution to avoid exaggerating any pre-existing hypotension.


Drug Interactions

Augmented effects may occur with concurrent use of methylergonovine and vasoconstrictors or ergot alkaloids


Stability

Ampuls must be protected from light and stored at temperatures 25°C (<77°F)


Mechanism of Action

Similar smooth muscle actions as seen with ergotamine; however, it affects primarily uterine smooth muscles producing sustained contractions and thereby shortens the third stage of labor


Pharmacodynamics/Kinetics

Onset of oxytocic effect: Oral: 5-10 minutes; I.M.: 2-5 minutes; I.V.: Immediately

Duration of action: Oral: ~3 hours; I.M.: ~3 hours; I.V.: 45 minutes

Absorption: Rapid

Distribution: Rapidly distributed primarily to plasma and extracellular fluid following I.V. administration; distribution to tissues also occurs rapidly

Metabolism: In the liver

Half-life (biphasic): Initial: 1-5 minutes; Terminal: 30 minutes to 2 hours

Time to peak serum concentration: Within 30 minutes to 3 hours

Elimination: In urine and feces


Usual Dosage

Adults:

I.M.: 0.2 mg after delivery of anterior shoulder, after delivery of placenta, or during puerperium; may be repeated as required at intervals of 2-4 hours

I.V.: Same dose as I.M., but should not be routinely administered I.V. because of possibility of inducing sudden hypertension and cerebrovascular accident


Mental Health: Effects on Mental Status

May rarely cause dizziness or hallucinations


Mental Health: Effects on Psychiatric Treatment

None reported


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

No effects or complications reported


Patient Information

This drug will generally not be needed for more than a week. You may experience nausea and vomiting (small frequent meals may help), dizziness, headache, or ringing in the ears (will reverse when drug is discontinued). Report any respiratory difficulty, acute headache, or numb cold extremities, or severe abdominal cramping. Breast-feeding precautions: Breast-feeding is not recommended.


Nursing Implications

Ampuls containing discolored solution should not be used


Dosage Forms

Injection, as maleate: 0.2 mg/mL (1 mL)

Tablet, as maleate: 0.2 mg


References

de Groot AN, van Dongen PW, Vree TB, et al, "Ergot Alkaloids. Current Status and Review of Clinical Pharmacology and Therapeutic Use Compared With Other Oxytocics in Obstetrics and Gynaecology," Drugs, 1998, 56(4):523-35.


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